ENABLING AGING IN PLACE: THE IMPACT OF HOME MODIFICATIONS ON NURSING HOME ADMISSION RISK

Abstract In an era where the built environment profoundly shapes the ability to age in place, this study aims to investigate the relationship between home modifications and the risk of nursing home admission. Using data from the 2000-2018 Health and Retirement Study, Cox proportional hazard models are employed to analyze the impact of various modifications on admission risk for older adults in the United States (N = 31,133). The home modifications considered include the presence of ramps, railings, wheelchair modifications, grab bars/shower seats, and an emergency call system. The results indicate that having a grab bar/shower seat in one’s home is consistently associated with a decreased risk of nursing home admission (HR = 0.42, CI = 0.34, 0.52). However, there is mixed evidence for the remaining modification. These findings underscore the potential significance of incorporating grab bars and shower seats into building codes and promoting their installation in homes. Such modifications may play a vital role in promoting independent living and reducing reliance on institutional care. Further research is needed to explore the underlying mechanisms by which home modifications influence the risk of nursing home admission.

indicated that experience working in MAID-legal states (vs.not; OR = 2.42, p = .002)and increased orientation toward patient-centered care (OR = 1.38, p < .001)were significantly associated with higher odds of greater MAID support across thresholds.Conversely, the direction and statistical significance of commitment to the hospice philosophy of care depended on the threshold of the dependent variable (odds of MAID support higher than "oppose": OR = 0.98, p = .326;odds of MAID support higher than "neither support nor oppose": OR = 1.05, p = .043).Findings provide the first quantitative evaluation of a predominantly theoretical debate concerning perceptions of MAID's concordance with hospice values.Noting legal protections for conscientious objection, higher support from clinicians in states where MAID is legal may suggest training opportunities as levers to improve patient access.

EFFECTS OF THE COVID-19 ON MEDICAL USE OF ELDERLY PATIENTS WITH HYPERTENSION: A NATIONWIDE COHORT STUDY IN KOREA.
Eunbyul Cho, Seoul National University of Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea COVID-19 pandemic disrupted healthcare services, including chronic disease management for vulnerable groups like older individuals with hypertension.This study aims to evaluate hypertension management in South Korea's elderly population during the pandemic using treatment consistency indices like Continuity of Care (COC), Modified, Modified Continuity Index (MMCI), Most Frequent Provider Continuity (MFPC).This study used the the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort (K-COV-N cohort) from the National Health Insurance Service (NHIS) between 2017 and 2021 The research included a total of 4,097,299 hypertensive patients aged 65 or older.We defined 2018 and 2019 as baseline period before COVID 19 pandemic, and 2020 and 2021 as COVID 19 period, and calculated the indices of medical continuity (Number of visits, COC, MMCI and MFPC) on a yearly basis were measured.The number of visits were decreased during COVID 19 period compared to baseline period ( 59.64 ±52.75 to 50.49 ± 50.33, p< 0.001) respectively.However COC, MMCI and MFPC were not decreased in baseline period compared to COVID-19 period ( 0.71 ± 0.21 vs. 0.71 ± 0.22, p< 0.001), (0.97 ± 0.05 vs. 0.96 ± 0.05, p< 0.001), and (0.8 ± 0.17 vs. 0.8 ± 0.17, p< 0.001) respectively.In conclusion, COVID-19 had no significant impact on continuity of care, but it did affect the frequency of outpatient visits of older hypertensive patients.However, this study highlights the importance of addressing healthcare inequalities, especially for older hypertensive patients, during pandemics and advocates for policy changes to ensure continued care for vulnerable populations.

ENABLING AGING IN PLACE: THE IMPACT OF HOME MODIFICATIONS ON NURSING HOME ADMISSION RISK Yuliana Levchenko, Portland State University, Portland, Oregon, United States
In an era where the built environment profoundly shapes the ability to age in place, this study aims to investigate the relationship between home modifications and the risk of nursing home admission.Using data from the 2000-2018 Health and Retirement Study, Cox proportional hazard models are employed to analyze the impact of various modifications on admission risk for older adults in the United States (N = 31,133).The home modifications considered include the presence of ramps, railings, wheelchair modifications, grab bars/shower seats, and an emergency call system.The results indicate that having a grab bar/shower seat in one's home is consistently associated with a decreased risk of nursing home admission (HR = 0.42, CI = 0.34, 0.52).However, there is mixed evidence for the remaining modification.These findings underscore the potential significance of incorporating grab bars and shower seats into building codes and promoting their installation in homes.Such modifications may play a vital role in promoting independent living and reducing reliance on institutional care.Further research is needed to explore the underlying mechanisms by which home modifications influence the risk of nursing home admission.

MAKING OLDER ADULT FALL PREVENTION A ROUTINE PART OF HEALTHCARE IN TRIBAL CLINICAL SETTINGS
Gwen Bergen 1 , Leo Egashira 2 , Myra Parker 2 , Shakiera Causey 3 , and Yara Haddad Over one-third of American Indian and Alaska Native (AI/AN) elders (age 65+) report falling annually.This percentage is higher compared to other race/ethnic groups except for White non-Hispanic older adults.CDC's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative provides guidance for making elder fall prevention a routine part of clinical care.The presentation will describe a survey of healthcare providers serving AI/AN populations to gauge their readiness to adopt STEADI.Additionally, it will focus on a culturally informed approach to implementing STEADI within tribal settings.The National Network of Public Health Institutes and Seven Directions, A Center for Indigenous Public Health, surveyed a convenient sample of healthcare providers in clinics serving AI/AN patients to assess providers' knowledge and acceptability of fall prevention best practices, efforts to prevent falls, and receptiveness to receiving fall prevention training and support.The final sample included 94 healthcare providers from 27 clinics.Less than half of those surveyed reported screening elders for fall risk.Only 22% were familiar with STEADI.Most (84%) providers were willing to take part in fall prevention with additional training.Based on these findings CDC is funding two tribes to use an indigenous evaluation approach to improve their tribal health center's elder fall prevention capacity through evidence-based clinical and clinicalcommunity linked strategies.Results from these activities will be used to outline a best practices guide focused on coordinated care for fall prevention and tailored to the varied environments, governments, cultures, and capacity for public health action in tribal health centers.

SOCIALIZING CARE FOR OLDER PEOPLE ACROSS THE COUNTRIES: A COMPARATIVE STUDY OF THE LOCATION OF CARE
Aeji Jang, Yeonjung Lee, and Young Choi, Chung-Ang University, Seoul, Republic of Korea As more people are likely to prefer to age in their own place, where and how the care in later life is provided become more important.This paper aims to compare the degree of socialization in care for older people among different countries, especially focusing on the location of care (i.e., home care and institutional care).We applied the Fuzzy-set Ideal Type Analysis to classify the countries depending on how the formal care is provided between home and institutional settings.Measures of socialization in home care include the national expenditure on home care and the number of formal care workers at home, whereas formal care workers and the number of beds in residential LTC facilities are indicators for socialization in institutional care.The four different types of formal care will be classified: HI where both home and institutional cares are highly socialized; Hi where home care is highly socialized but institutional care is not; hI where institutional care is highly socialized but not home care; and hi where neither are socialized.Results show that Denmark, Australia, and the Netherlands belongs to HI; Japan to Hi, New Zealand, Switzerland, and Germany to hI; and Korea and the United States to hi.Findings suggest that countries with high level of socialization of home care are likely to have a care management system for coordinating and monitoring services.This study provides implications for considering the unique cultural, institutional, and policy contexts among the countries in regards to the degree of socialization of care.LGBT older adults maintain unique social networks.They are more likely to live alone, more likely to rely on peers for caregiving, and less likely to have intergenerational support to adopt technologies that help maintain relationships.This research explores how LGBT older adults used technology for social support during COVID-19 social distancing and identifies recommendations for improving social isolation and wellbeing in this population through telehealth guidelines and community programs.Semi-structured individual interviews were conducted with a racially and ethnically diverse sample of 15 LGBT older adults during the summer of 2020.Interview guides were designed according to The Convoy Model of Social Relations.Verbatim transcripts were coded using conventional content analysis.Three major themes were identified, highlighting ways LGBT older adults used technology to meet social support needs, and the perceived gaps in technological fluency that hinder social connectedness and telehealth acquisition: (I) Yearning for "The Hug Factor," (II) Navigating 1 , 1. Centers for Disease Control and Prevention, Atlanta, Georgia, United States, 2. Seven Directions Public Health Institute, Seattle, Washington, United States, 3. National Network of Public Health Institutes, New Orleans, Louisiana, United States